Genova Diagnostics
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United States
United States
Market United States United Kingdom International

myGDX Provider Application

To process this application, a copy of your professional license is required.

* Indicates Required Information

Account Information

Provider Details

Provider's Healthcare License

A valid medical provider license is required to create a myGDX account.

Need help finding your license?

  • Visit your State Licensing Board website (often under "License Lookup").
  • Search the NPI Registry at https://npiregistry.cms.hhs.gov.
  • Providers licensed outside of the US should check with their country's health ministry or regulatory body regarding appropriate documentation.
  • Providers licensed outside of the US should check with their country's health ministry or regulatory body regarding appropriate documentation.

Shipping Address

Collection packs will be sent to this address.

Account Billing Options

Billing Contact Information

Select the option that best fits your ccount:

Want to combine your account for reasons other than billing? Submit your application then contact your account rep.

Billing Address

Billing Preferences

Our account setup team may adjust these options to meet your region's regulatory requirements.

1 You will need to provide your credit/debit card information so that we can successfully set up this billing method. You can only do this by phone (+44 (0)20 8336 7750). Your card details will be stored in accordance with PCI DSS standards. Once stored, we are only able to see the last 4 numbers of the card and the expiry date.
2 Not available for sole traders. Deduct Card and Practice Monthly options will also be billed for all outbound and inbound shipping charges.
*Genova Diagnostics will quote payment amounts to patients who are using our insurance billing and no insurance billing options.

Bill Provider Account

At the beginning of each month, Genova Diagnostics will provide a comprehensive list of charges made to your card. Automated payments will be charged at the end of each month for any balances remaining on the account.

Please provide your card details and specify your preference for storing and using it for balances billed to your professional account.

I authorize Genova Diagnostics to charge my card:

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